What is female genital mutilation?

A Detroit area physician faces federal charges for allegedly performing female genital mutilation on multiple 6- to 7-year-old girls as part of a religious and cultural practice at a medical clinic in Livonia.
Detroit Free Press

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Detroit area physician Jumana Nagarwala has been charged with performing genital mutilation on multiple girls. Her bio is posted on the Henry Ford Health System website.(Photo: Detroit Free Press)Buy Photo

Millions of little girls and young women have been subjected to a painful rite of passage that involves cutting their genitals — often without anesthesia — for centuries in parts of Asia, Africa and the Middle East.

In some cultures and religions, it’s believed that female genital mutilation preserves a girl’s chastity, making her a more desirable marriage partner, and improving hygiene and fertility.

But there are no health benefits to the practice, according to the World Health Organization. For most of the girls, it brings only pain, cysts, scars, infections, and problems with urination and childbirth. It also leads to a higher risk of infant death and psychological trauma.

Human rights organizations widely condemn the practice, not only for the health risks but also because of the underlying injustice.

"It reflects deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women," the WHO says on its website. "It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death."

When it's performed abroad, often midwives or trained circumcisers travel among villages to perform female genital mutilation en masse, using and reusing knives, razors and scissors without sterilization. There often are celebrations that include singing, gifts and food.

More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia, according to WHO, and the procedure is most commonly performed on girls who range in age from infancy to 15.

The practice can take many forms, and may involve removing only a portion of the external genitalia, such as the clitoris and labia minora, or it can involve the removal of most of the external genitalia and a narrowing of the vaginal opening or other harmful procedures such as scraping, pricking, piercing or cauterizing the genitals.

Although it’s now against federal law to practice female genital mutilation in the U.S., Reviews in Obstetrics & Gynecology reported that American obstetricians performed clitoridectomies on lesbians until the 1960s and on women diagnosed with erotomania, hysteria and clitoral enlargement.

The foundation, which was created by women's rights activist Ayaan Hirsi Ali, who suffered female genital mutilation as a girl in her native Somalia, suggests that even with the federal laws in place, it's important for states to have laws banning the practice.

"In addition to giving prosecutors additional tools to use to prosecute cases, it also sends a strong message that this harmful practice is not tolerated here," said Amanda Parker, senior director of the AHA Foundation.

"Until now, there had been no prosecutions under FGM laws to date, but other laws have been used to punish families who cut their daughters. In 2006, a father in Georgia was convicted of battery and cruelty for removing his daughter’s clitoris and was sentenced to 10 years in prison. He was recently deported after serving his sentence. In 2010, a mother in Georgia was charged with FGM after her 10-year-old daughter was found to have been cut."

Dr. Jumana Nagarwala, 44, of Northville, an emergency room doctor at Henry Ford Hospital, is presumed to be the first to be charged under federal law with a female genital mutilation crime on U.S. soil. She is accused of performing genital mutilation on multiple 6- to 8-year-old girls as part of a religious and cultural practice at a medical clinic in Livonia.

Parker said it's difficult to know how many girls and women have undergone genital mutilation in the U.S. because it's a private ritual that usually occurs within the secrecy of a family.

But the U.S. Centers for Disease Control and Prevention estimated in 2014 that 513,000 women and girls in America had either undergone the procedure or were at risk for genital mutilation — a number that doubled since 2000. The estimates have been on the rise, Parker said, because of an influx of immigrants from countries where female genital mutilation is common.

"The increase in FGM in the U.S. is almost entirely, if not entirely, due to the increase in immigrants from countries where FGM is practiced," Parker said. "Somalia, Egypt, Sudan and others all have very high rates of FGM with more than 90% of girls in each country undergoing this abusive practice.

"In the U.S., FGM is either performed in secret or girls are taken to their families’ country of origin for the procedure. This is a practice referred to as 'vacation cutting,' as it is typically done during school holidays so as not to bring attention to girls being absent from school in order to heal."

The AHA offers a 24-hour, free anonymous crisis help text line to girls and women who've undergone FGM, who fear they are in danger of genital mutilation, or who face honor violence or forced marriage. Text FREE to 741-741.